Lactose Controlled Diet

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Use: This diet is used to prevent or reduce bloating, flatulence, cramping, and diarrhea associated with ingesting lactose-containing products. This diet is used by people who are lactose intolerant or have been diagnosed with lactase deficiency. Lactose intolerance is the inability to digest significant amounts of lactose, the predominant sugar of milk. Since tolerance of lactose may vary, the diet is usually administered on a trial and error basis.

Tips:

• Labels should be read carefully and foods containing milk, lactose, milk solids, whey, curds, skim milk powder/solids should be avoided. Medications may contain lactose. Lactate, lactalbumin, lactylate, and calcium compounds are salts of lactic acid and DO NOT CONTAIN LACTOSE.
• Look for lactose reduced and lactose free milk products. The lactase enzyme has been added to the milk so the lactose is broken down and the milk is easier to digest.
• Try Lactaid Milk ‚ it has the same amount of calcium per serving as milk.
• Turn any carton of milk into lactose-reduced milk by adding a few drops of a lactase enzyme preparation (sold at most pharmacies). You can also take diary digestive supplements (enzyme supplements) before drinking milk or eating dairy products.
• Lactose intolerance is not an "all or nothing". Lactase levels vary from person to person and are manageable.
• Try small, frequent portions of milk and milk products. This allows whatever lactase is present to do its job of digesting the lactose before it starts causing problems.
• Start with a smaller portion and gradually increase the serving size of the dairy foods you consume. Experiment and work up to the amount that is good for you.
• Drink milk with other foods, rather than on an empty stomach. Solid foods slow the digestive process and allow the body more time to digest the lactose, which help to decrease or eliminate symptoms.
• When milk is processed into cheese, most of the lactose removed in the whey. Aged hard cheese such as Cheddar, Colby, Swiss and Parmesan are low in lactose.
• Look for cultured milk products such as yogurt or buttermilk. These products contain friendly bacteria that help digest lactose.
• Calcium is absorbed and used only when there is enough vitamin D in the body. A balanced diet should provide an adequate supply of vitamin D. Sources of vitamin D include eggs and liver. However, sunlight helps the body naturally absorb or synthesize vitamin D, and with enough exposure to the sun (10 minutes a day during warm months), food sources may not be necessary.
• Keep a food diary and write down foods that give you symptoms.
• See a dietitian to help devise an individual meal plan.

In 1997, the Institute of Medicine released a report recommending new requirements for daily calcium intake. How much calcium a person needs to maintain good health varies by age group. Recommendations from the report are as follows:

Age group	Amount of calcium to consume daily in milligrams (mg)
0-6 months	210 mg
6-12 months	270 mg
1-3 years	500 mg
4-8 years	800 mg
9-18 years	1,300 mg
19-50 years	1,000 mg
51-70 years	1,200 mg

Also, pregnant and nursing women under 19 need 1,300 mg daily, while pregnant and nursing women over 19 need 1,000 mg.

Figure 2. Calcium and Lactose in Common Foods

Sample Menu for Lactose Controlled Meal Plan
2100 Calories, 28%Kcal from fat, 1500mg of Calcium

Breakfast Orange juice (1/2 cup) Whole grain cereal (3/4 cup) Banana (1/2) Whole-wheat toast (2) Margarine (2tsp) Jelly (1 tbsp) Lactose reduced 1% milk (1cup) Lunch Vegetable soup (1 cup) Saltine Crackers (4) Turkey Breast (3 oz) Rye Bread (2) Mayonnaise (1 tsp) Tomato & Lettuce Fruit Salad (1cup) Lactose Reduced 1% milk (1 cup)

Dinner Green Salad (1 cup) Salad Dressing (1 tbsp) Baked Chicken Breast (3 oz) Rice (1/2cup) Steamed Broccoli (1/2 cup) Whole Grain roll (1) Margarine (2 tsp) Apple (1) Snack 4 graham crackers Lactase ‚reduced 1% milk

Sources:

• National Digestive Diseases Information Clearinghouse
  2 Information Way
  Bethesda, MD 20892-3570
  301-654-3810
  http://www.niddk.nih.gov
• Manual of Clinical Dietetics
  4th Edition
  1992, The American Dietetic Association
• 1999 National Fluid Milk Processor Promotion Board
  1250 H Street
  Washington, D.C. 20005

By: Emily Rubin, RD
Registered Dietitian for Division of Gastroenterology and Hepatology
To contact for questions or to make an appointment:
e-mail: Emily.Rubin@jefferson.edu
phone: 215-955-4152